Social Determinants 101 by Megan Kimitsuka

One of the largest motivators in my decision to serve a year with National Health Corps was the desire to understand public health in “real life.” My undergraduate education in public health provided me with a textbook understanding of holistic healthcare and the impact of social issues on health, but I wanted to see how these factors affected people on the ground. So far during the course of my service term as a patient advocate at Health Center 4, I felt as though I’ve received a crash course in the true meaning of social determinants of health.

My primary role is to coordinate enrollment in the Prescription Assistance Program, which enables patients who meet certain eligibility requirements to receive their medications for free. At face value, this seems like a program that may not give great insight into the underlying social factors that a patient experiences; however, it’s quite the opposite. Nothing better illustrates this relationship between social factors and health than a patient I first met this past October.

A nurse came into my office to let me know a patient was waiting for me. She handed me a piece of paper and told me that she had asked them to sign in, and then left. Typically the nurses hand me a prescription or a referral from the patient’s physician, but this paper was something I had never seen before. It was a bill from an outside pharmacy for medication prescribed by a urologist. The total was $394 for a single month of pills.

Further discussion with the patient revealed other aspects of their life that made the situation more complicated: they worked part-time, they had a young family, and they were a student - with emphasis on the use of past tense when referring to their studies, because they had to drop out of their classes to pay for the medication. They said that the urologist believed that early childhood health problems and diet had led to the condition that necessitated the expensive medication. As the medication was required for daily functioning, the patient had no other choice but to do whatever necessary to pay the $394.

There are so many factors involved in a patient’s care that are beyond what occurs in the health center: the social determinants of health. Social determinants of health can be things like one’s childhood experiences, diet, access to care, education, and more. They are often beyond individual control, stressful, and require choosing (or, perhaps more often, lacking any choice at all) between endeavors many of us take for granted, such as pursuing higher education or seeing a specialist for our care.

Thankfully, this patient was approved for the Prescription Assistance Program and will receive their medication free of charge for the next year. The sound of relief in their voice when they thanked me is something I will never forget. I am so grateful to be a small part of the care team of patients like this one, and I will continue to serve as an advocate for patients both in and out of the health center for the rest of my service term and beyond.